Pain as a fifth vital sign in a standardized pain flow sheet: impact on patient-reported pain experience after cardiovascular surgery

Random pain assessments and the subsequent administration of analgesics may provide inadequate pain management, which is a major health care problem. To improve the quality of pain management, pain should be assessed as the fifth vital signs in a standardized pain flow sheet, because pain assessment is rarely complete, and because health care professionals are poor predictors of patient's pain. Thus the present study was conducted to examine the impact of nurses' use of a standardized pain flowsheet to document pain assessment and pharmacologic management on patient reported pain intensity after cardiac surgery. A pre and post implementation design was used to compare 51 patients from Cardiac Surgical Units in Shark El Madina Hospital /Ministry of Health/ Alexandria and Mansoura University Hospital. For the first [28 patients] in the pre-implementation group, traditional charting of presence or absence of pain was documented in the narrative notes and the pharmacologic management was documented in the medication profile. In the post-implementation group [23 patients], the intensity of pain and pharmacological management were documented on a pain flowsheet. Within 24 hour patients were interviewed regarding pain intensity experienced in the surgical heart unit and at the time of questioning. The distribution of these pain intensity scores was compared. Results revealed that the use of a standardized pain flowsheet to assess pain intensity and document pharmacological intervention improved pain management in post operative cardiovascular patients. Use of this scale helps patients quantify pain intensity and relief and requires the health care member to be accountable for providing effective management of pain

End of life care issues: nurses' perception

Management of the dying has received considerable attention during the last decade. Studies have revealed that care of the dying patient receives little attention in the medical and nursing curriculum or in critical care orientation programs and literature. As a result nurses as well as physicians often feel unprepared to deal with end-of-life issues. Thus the aim of this study is to identify nurses' perception of end of life care issues. The study was conducted in the critical care units and the medical surgical units of the Alexandria Main University Hospital University of Alexandria. A convenient sample of 176 nurses providing direct patient care were included in the study. A structured interview sheet was developed by the researchers. The tool covered 6 broad areas namely, characteristics of the studied sample, nurses' perception regarding: the adequacy of basic nursing education program in aspects of end of life care, aspects of end of life care provided, dilemmas in end of life care, barriers, helps to providing good end of life care to dying patients and their families. A statistical significant association was found between qualification of nurses and the adequacy of basic nursing education program in aspects of end of life care. Also a significant association exists between aspects of end of life care provided and the different working areas. As well as between the frequency of dilemmas in end of life care occurrence and the different working areas. Among the top items perceived by nurses as barriers to providing good end of life care to dying patients were: physicians giving false hope and lack of knowledge by health care professionals. Whereas, among helps to providing good end of life care: having family shows appreciation to nurses for care of patient, followed by health professionals teaching families how to act with dying patient or what to say. There is a crucial need for better education of health care team members about end of life care focusing on how to support families, ensuring respect for various religious and cultural beliefs and emphasizing general communication and teamwork skills

Brain Tumor patients: nursing diagnostic priorities

This study was conducted to identify common problems encountered by patients with brain tumors using Roy's Adaptation Model and to formulate nursing diagnostic priorities for patients with brain tumors. Sample [N = 68] consisted of patients with a diagnosis of brain tumor. Age ranged from 18 to 63 years. Findings showed that, most of the brain tumor patients' problems fall in the basic physiological mode of Roy's Adaptation Model while, few of problems fall into the three other modes of adaptation; namely, self-concept, role function and interdependence. Significant difference between both sexes was found regarding the postoperartive complications. However, age was not found to affect the occurrence of these complications. It is assumed that, nursing diagnosis would be the keystone of the care plan of brain tumor patients in improving the quality of delivered patients care for such specialized group of patients